Intraperitoneal Chemotherapy
For our purposes we are going to focus on Ovarian Cancer and the use of chemotherapy drugs, Cis-platin and Taxol.

What is Intraperitoneal Chemotherapy?

Intraperitoneal therapy (IP) is the administration of chemotherapy agents into the peritoneal cavity. IP therapy is used to treat intra-abdominal malignancies such as ovarian and gastrointestinal tumors that have moved into the peritoneum after surgery. Catheters used for IP therapy may be an implanted port for long-term treatment or an external catheter for temporary use. These catheters, including those attached to an implanted port, have large internal lumens with multpile side-holes along the catheter length to allow for delivery of large quantities of fluid. Administration of IP therapy includes three phases: the instillation phase; the dwell phase, usually 1 to 4 hours; and the drain phase. Because this treatment involves the delivery of biohazardous agents, additional competency is required to handle the infusion properly.

http://www.cancercenter.com/conventional-cancer-treatment/chemotherapy/intraperitoneal-chemotherapy.cfm

What can we expect as Nurses to do with the patient who is receiving this type of infusion?

The patient should be in the semi-Fowler's position for the infusion. He or she may experience nausea and vomiting caused by increasing pressure on the internal organs from the infusing fluid. Pressure on the diaphragm may cause respiratory distress. Reducing the flow rate and treatment with antiemetic drugs are indicated. Severe pain may indicate that the catheter has migrated, and an abdominal radiograph is needed to determine its location.

During the dwell and drainage phases, the patient may need assistance in frequently moving from side to side to distribute the fluid evenly around the abdominal cavity. After the fluid has drained, the catheter is flushed with normal saline, although heparinized saline may be used in implanted ports. Catheter lumen occlusion is caused by the formation of fibrous sheaths or fibrin clots or plugs inside the catheter or around the tip.

Exit site infection, indicated by redness, tenderness, and warmth of the tissue around the catheter, can occur. MIcrobial peritonitis and inflammation of the peritoneal membranes from the invasion of microorganisms are other complications. If peritonitis occurs, the patient may experience fever and report abdominal pain. Abdominal rigidity and rebound tenderness may be present. This condition is preventable by using strict aseptic technique in the handling of all equipment and infusion supplies. Management includes antimicrobial therapy administered either intravenously or intraperitoneally.

Drug Therapy:

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What kind of chemotherapy agent is Cis-platin?

Cisplatin is a chemotherapeutic agent used most commonly with these types of cancers:

Bladder cancer that cannot be treated with surgery or radiation
Cervical cancer that is advanced and cannot be treated with surgery or radiation
Malignant mesothelioma
Non-small cell lung cancer that is locally advanced or metastatic throughout body
Ovarian cancer that is advanced or metastatic throughout body
Squamous cell carcinoma of the head and neck that is locally advanced and cannot be treated with surgery
Testicular cancer in patients who have already had surgery or radiation

Side effects of Cisplatin:

Nausea
Vomiting
Diarrhea
Hair loss
Hiccups
Loss in ability to taste food
dry mouth, dark urine, decreased sweating, dry skin and other signs of dehydration

What kind of chemotherapeutic agent is Taxol?
What is Taxol? Taxol is an anti-cancer ("antineoplastic" or "cytotoxic") chemotherapy drug. Taxol is classified as a "plant alkaloid," a "taxane" and an "antimicrotubule agent."

What Taxol Is Used For:

Taxol is used for the treatment of breast, ovarian, lung, bladder, prostate, melanoma, esophageal, as well as other types of solid tumor cancers. It has also been used in Kaposi's sarcoma.

How is Taxol given?

Taxol is given as an injection or infusion into the vein (intravenous, IV).
Taxol is an irritant. An irritant is a chemical that can cause inflammation of the vein through which it is given. If the medication escapes from the vein it can cause tissue damage. The nurse or doctor who gives Taxol must be carefully trained. If you experience pain or notice redness or swelling at the IV site while you are receiving Taxol, alert your health care professional immediately.
Because severe allergic reactions have occurred in some people taking Taxol, you will be asked to take medications to help prevent a reaction. Your doctor will prescribe the exact regimen.
Taxol is given over various amounts of times and in various schedules.
There is no pill form of Taxol.
The amount of Taxol and the schedule that it is given will receive depend on many factors, including your height and weight, your general health or other health problems, and the type of cancer or condition being treated. Your doctor will determine your dose and schedule.

Side effects of Taxol:
The following Taxol side effects are common (occurring in greater than 30%) for patients taking Taxol:

Low blood counts. Your white and red blood cells and platelets may temporarily decrease. This can put you at increased risk for infection, anemia and/or bleeding.
Hair loss
Arthralgias and myalgias, pain in the joints and muscles. Usually temporary occurring 2 to 3 days after Taxol, and resolve within a few days.
Peripheral neuropathy (numbness and tingling of the hands and feet)
Nausea and vomiting (usually mild)
Diarrhea
Mouth sores
Hypersensitivity reaction - fever, facial flushing, chills, shortness of breath, or hives after Taxol is given. The majority of these reactions occur within the first 10 minutes of an infusion. Notify your healthcare provider immediately (premedication regimen has significantly decreased the incidence of this reaction).

Nursing Interventions for patients receiving Cisplatin/Taxol:

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